What’s behind the racial disparities in Minnesota opioid overdose deaths?

CATHY WURZER: A data story out today by Sahan Journal underscores a terrible reality. Opioid overdoses, mainly fentanyl, killed more than 4,000 Minnesotans from the year 2019 through 2023. And there have been dramatic racial disparities that have only grown as death rates show signs of maybe leveling off.

This is especially true for Native Americans who, in those five years, were 15 times more likely to suffer a fatal overdose than white people. Minnesotans who did not go to college are also more likely to die from opioids.

Joining us right now to talk about what's behind the numbers and what they leave out are two health care providers who are working to prevent more opioid deaths. Dr. Antony Stately is a clinical psychologist and the president and executive officer of the Native American Community Clinic. Dr. Dziwe Ntaba is an emergency medicine physician and an assistant professor at the University of Minnesota Medical School.

Doctors, thank you for joining us. We appreciate your time.

ANTONY STATELY: Thank you.

DZIWE NTABA: Thanks, Cathy.

CATHY WURZER: Dr. Stately, I'm going to begin with you. The Sahan Journal analyzed 240,000 death certificates for this story. And an epidemiologist they talked to says Minnesota is the state with the largest gap in overdoses among Native American and white people. Do you find any surprises in that data?

ANTONY STATELY: Actually, the article is a really wonderful piece of, I guess I would say, relief from the perspective of it reflects, I think, accurately the lived experience of certainly the people that work in my clinic and the community we serve and certainly many of the other folks who work in leadership roles that I have a conversation with on a regular basis about the impact that this epidemic is having on our specific community, specifically here within South Minneapolis.

CATHY WURZER: Can you tell me a little bit about the folks? What are their stories, the individuals who you see? I'm curious. Just obviously, we have HIPAA laws, but just what are some of the stories you hear?

ANTONY STATELY: Well, I think that there's a couple of things that I hear. And I don't serve people directly myself as the executive officer. I'm not in the service delivery capacity. A lot of my staff, who I do spend time talking with, we are serving people who are really very in desperate situations. Many of them, if they weren't homeless before they started substance use, maybe they became substance users after they became homeless.

We have significant experiences with Native people within South Minneapolis that are not the kinds of things that you would necessarily see with other people who are struggling with opioid-use disorders across Minnesota or across the nation.

We have people who have deep, deep poverty, who have been in and out of incarceration experiences, who have-- I think one piece of this specific analysis that's really quite telling is just the scale of the amount of the impact that it is having among people who have not had advanced education beyond high school.

The state of Minnesota has had significant failures in graduating Native people, American Indian people across the state for quite some time. Those things got worse during the pandemic.

And I think the other piece of information that was really impactful for me was the scale of the amount of numbers of people who are being impacted by early death, by overdose, who are young, who are between the ages of 18 and 34. These are people who have struggled in our community for a very long time.

CATHY WURZER: Dr. Ntaba, I'd like to jump to you, if I could, please. What do you think happened to get us to this point where overdose deaths are really affecting one group more than others?

DZIWE NTABA: Well, I think that's a really important question. And I certainly spent most of my professional time outside of the hospital setting trying to better understand that. Through my research, I've come to believe that the overdose death disparities are explained by a lack of access to medication, understanding that opioid-use disorder is a biological disease that affects the brain.

There are changes like tolerance and dependence that happen in the brain, which mean that these patients require medication to stabilize those changes in the brain so that they can regain normal lives. And one of the things that article looked at in the Sahan Journal today is some of the different rates of access to medication.

You can look at disparities either by demographic group like the article did or by age group or even by geographic location. And the common denominator to me that I see in the data is lack of access to medication drives opioid-overdose deaths.

So in this particular instance, there are challenges amongst the groups discussed in accessing medication. But the answer is still the same. Getting more people onto medication leads to fewer deaths. And conversely, the fewer people on medication leads to more death.

CATHY WURZER: And just for folks to be really clear here, when you talk about medication, are you talking about Narcan or that and other medications to help individuals?

DZIWE NTABA: Yeah, thanks for clarifying that. Narcan-- or naloxone is the generic name-- is a very important tool for resuscitating somebody who is in the process of overdose. But what I'm referring to when I talk about medication is specifically medication for opioid-use disorder, medications like buprenorphine. Or suboxone is one of the more common generic brand names.

It's these types of medications that are critically important in changing the trajectory not only for patients, meaning these meds act to rapidly stabilize patients, treating withdrawal symptoms within a matter of an hour or two. They also eliminate cravings, especially if taken in the long run, and they also prevent overdose.

So they act very differently from naloxone or Narcan, which, like I say, is an important tool, but it's not a game-changer. It's not something that can flatten or reverse the curves when it comes to mortality, overdose deaths. So a large part of my work is trying to get people-- trying to get the word out, one, public health messaging. These are the risks of opioids nowadays, especially with fentanyl being so ubiquitous.

And two, health promotion, helping people understand if they're affected by this disease or if they have loved ones who are struggling with it. The exit ramp is really getting onto medication like buprenorphine.

CATHY WURZER: And thank you for the clarification. I appreciate it. Dr. Stately, are there interventions out there that are giving you some hope?

ANTONY STATELY: Yeah. I think NACC operates a medication administration program in our clinic where we provide daily suboxone or weekly takeout and those kinds of things for people who are further along in their recovery journal-- journey, rather. And we have been doing that now for about two or three years.

We've centered culture. We put a lot of cultural activity and cultural resources and support and spiritual-care services within that sort of space as well to provide a more accessible, I guess, space for people to feel comfortable coming into our place and getting and seeking help and getting support.

We operate from a harm-reduction perspective, meaning we really provide low-barrier access to our services at our clinic. We don't require people to have all of their things put together in their lives in a nice, neat order to be able to walk through the front door and get our work.

I think one of the things I would agree strongly with what Dr. Dziwe was talking about, which is, yes, having access to these life-saving things is really important. It's the thing that will change these outcomes for every community. But access is more than just having it available on the shelf or having it available in the space.

I think my comments in that article reflect some of the challenges that our community specifically has had in some of the spaces where they go and ask for help. They find it difficult to walk into a pharmacy. They experience stigma, discriminatory experiences. Some people feel dehumanized in those spaces.

And when you are treated in a specific way in those spaces that are intended to be supportive and helpful and healing, people don't want to go back. And what that does is it makes them more vulnerable to actually overdosing and dying.

CATHY WURZER: Dr. Dziwe, same question to you. Any interventions or programs that give you hope?

DZIWE NTABA: Yeah, absolutely. I've been working really closely with the Minneapolis Health Department to expand, essentially, on what Dr. Stately is saying, low-barrier access to medication. In my clinical environment-- I work in the emergency department-- we see large numbers of people struggling with this disease and not yet on medication.

So we are looking at ways to expand access by providing rapid same-day access to the medications, buprenorphine, in our case, through the emergency department and through the hospital settings. And then on top of that, in order to try and address this oftentimes negative patient experience is the language that we use that Dr. Stately is referring to.

We also have a navigator program that provides concierge service, essentially a warm, friendly face, as early as possible when those patients show up in our emergency room in order to, one, show that we have a culture of caring and two, really promote visibility of the emergency department as an access point for treatment.

That being said, we can get patients stabilized in the emergency department, but we need to send them on to a continuum of care that will continue those medications. So I have every confidence, say, in Dr. Stately's clinic, in their ability to maintain these medications and especially at the right doses.

But I think we have a lot of room for improvement across the metro area based on what I've seen to enhance and maintain that continuum of care that's grounded in the evidence base around the medications.

CATHY WURZER: I appreciate both of what you've said, both of you, and the time that you're spending on this. Thank you so very much for helping us paint a picture as to what's going on in the community. We appreciate it.

ANTONY STATELY: Thank you, Cathy.

DZIWE NTABA: Thanks for having us.

CATHY WURZER: We've been talking to Dr. Dziwe Ntaba, an emergency medicine physician and an Assistant Professor at the U of M's medical school. And Dr. Antony Stately is the president and executive officer of the Native American Community Clinic. Now, the Sahan Journal story we've been talking about is the first in a series. You can find it at mprnews.org. You can also go to Sahanjournal.com.